Health Committee on April 16th, 2007

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

Okay. Does that apply to the other two arms of that group as well?

[Mark Ferdinand]

It would probably be most appropriate to hear from Health Canada and the Canadian Agency for Drugs and Technologies in Health on that issue.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

Okay. Thank you.

You also made statements that you feel they're unaccountable and lack transparency. What do you base that on? Is it because you've tried to get these answers?

[Russell Williams]

It's difficult to get answers. We were talking about political experience. You want to make sure that somebody is accountable, and this body is not accountable to a minister. It's very difficult to actually put your finger on who is running the CDR and how decisions are being made. When you want to challenge those decisions, it's hard to interface with that body.

[Patricia Davidson, Conservative, Sarnia—Lambton, ON]

Then you talked about the medicine Sutent. Within four months of approval by Health Canada, Quebec agreed to fund it. Ontario has also provided access to it. So how did Ontario go about doing this if it wasn't through the CDR? Was it because the different provinces can support different products?

[Russell Williams]

That's right. The CDR is not binding. They don't have to listen to it. They don't have to listen to a rejection or a positive recommendation. So Ontario chose to move on part of the indication of that, as Quebec did.

[Mark Ferdinand]

The only thing I'd mention here is that if you look over time at the number of negative recommendations that have been made by CDR that resulted in positive recommendations by other provinces or drug plans, you actually see some variation. You see some 14 drugs listed in Quebec, even though they are not a participating plan, that received a negative recommendation from CDR. You see the NIHB with one or so. B.C., I believe, has listed a few that have received negative recommendations, and Ontario has listed 4 drugs that have received negative recommendations.

It just goes to the point that Mr. Williams raised earlier, and it really goes to the heart of the question of catastrophic drugs. Provinces are best placed to make decisions with regard to health care, and they do that across all other medically necessary services, so the question has to be who is best placed to make these decisions. It's our position that it certainly isn't a macro group, even if they are providing recommendations, as you'll certainly hear next week.

The fact is that those end up being de facto decisions in terms of what it means from the individual patient's point of view: do I have a choice of getting this or not? When you see those negative recommendations resulting in waits for a decision that may or may not come from a province, or a negative so we're not listing it, that really ends up being a de facto decision that harms patients.

[Russell Williams]

As you heard from Mr. Billen, these are not drugs where you want to have a barrier between the patient and the health care profession; you want to make sure these medicines get to these patients as soon as possible.

[Dr. Daniel Billen]

On the list I talked about, the seven drugs that were looked at as first-in-class drugs, one of the drugs on there is our own Sensipar. The product is used for people on dialysis, a very serious disease. Today, after a negative CDR recommendation, it is approved in Quebec for reimbursement, and it is actually under certain conditions approved in B.C. for reimbursement.

The irony of this is that this drug is manufactured in Canada for the world, and Canadian patients don't have access to it. It doesn't make sense. It just doesn't make sense. This product is available in France, in Europe in every country, but most provinces in Canada, except for Quebec and B.C., say no to these drugs based on a negative CDR recommendation. It does not do the patient justice.

[The Vice-Chair, Bloc, Christiane Gagnon]

Mr. Brown, I think that you are going to be the final speaker. Thank you.

[Patrick Brown, Conservative, Barrie, ON]

Thank you for your comments here today.

Generally when I look at a government program or any program that's involved in Canada—and I realize this is certainly provincially initiated—I look at how it affects the residents in the riding of Barrie, who I have the pleasure and honour of representing. There have been three occasions where I have had concerns brought to me about the common drug review. I want to bring them up and then get your comments, because I realize when we look at this that there's certainly a balance required between safety and prudence and, on the other hand, access and a patient focus. My concern is on the latter part in terms of the access and the patient focus.

I have had three examples brought to me by constituents. I had a daughter who came into my office and expressed concerns that Iressa was not available to her mother, who was suffering from cancer, and she complained about delays in Ottawa. You saw the frustration in her face and how it affected her family, and in that case it appeared that we had been a hurdle. I understand it has been approved in some provincial jurisdictions, but for some reason, with the common drug review, we inhibited what her doctor had told her mother would be something that would be helpful. I'm interested to know how that emerged.

Another example was a rare disease, Pompe disease. There was a resident in Barrie who suffered from that, and there was a drug available that was approved in Europe. It was approved by Health Canada, but it wasn't approved by the common drug review.

I also had a group of young individuals who suffer from type 2 diabetes who expressed concern about the length of time it takes to go through our channels.

You hear these examples, and I'm sure there are many you don't hear about. What are your sentiments? Is the benefit to safety outweighing this benefit for access? Are there examples of how this has helped with safety and prudence? Are there examples like this, that we're really losing on the other end?

[Dr. Daniel Billen]

First of all, if we look at Heath Canada, it is going to make the decision around advocacy and safety. So that's the first hurdle. I think they are in the best position to give you that balance. I think the more specialized the product is, the more safety concerns there are going to be as well. And sometimes it comes down to having the right balance between benefit and safety. It really is the jurisdiction of Health Canada.

All the examples you talked about are exactly the things we are talking about here today. Patients are living in a global world and understand what is available; they are holding on to that last hope about what they have out there. I don't think we provide patients with similar hope or access to what they would have in another province, such as Quebec, or in other countries, such as France, Germany, the U.K., and so on. So, really, I think you hit it on the nail here by saying that we will see more and more patients frustrated that there is something out there that potentially—and potentially is what I'm saying—could help them, but which they cannot get access to. They will ask, where did the system fail me?

I think that's where CDR plays an important role. Because their approach is predominately one of cost containment, they are going to deny many of these products to patients who are really at their end and are looking for hope and options.

[The Vice-Chair, Bloc, Christiane Gagnon]

That's your last question. Mr. Batters would like another word. You have taken almost five minutes, you have only about 30 seconds left. But if you want to speak, Mr. Brown—

[Patrick Brown, Conservative, Barrie, ON]

[Inaudible--Editor]

[Dave Batters, Conservative, Palliser, SK]

For 30 seconds or two minutes?

[The Vice-Chair, Bloc, Christiane Gagnon]

You have about a minute. There's not enough time left to ask a question.

I am giving the floor to Mr. Batters once more.

[Dave Batters, Conservative, Palliser, SK]

I'll go really fast, Madam Chair.

Gentlemen, whoever wants to answer, which government auditor or auditors review CDR and evaluate if there is value for money for taxpayers?

[Peter Brenders]

That's the same question we have.

[Dave Batters, Conservative, Palliser, SK]

So you guys don't know?

[Peter Brenders]

No, we don't.

[Dave Batters, Conservative, Palliser, SK]

Okay, thanks.

The next question is if CDR receives public funding but is not part of a single government body, then who provides oversight and who is accountable?

[Russell Williams]

That's exactly our question, and I think those are the questions you should be asking.

Why I highlighted the press communiqué of two days ago is that while we're moving forward with a review to understand the effectiveness and the efficiency of CDR, there's an announcement saying it is being expanded.

[Dave Batters, Conservative, Palliser, SK]

And the last question, gentlemen—and I really appreciate the intervention of my colleague Patrick Brown, who really put a human face on what we're talking about here today—is whether patients can appeal a decision by the CDR.

[Peter Brenders]

Not that I know of.

[Dave Batters, Conservative, Palliser, SK]

There's no patient appeal process whatsoever?